245997 06/03/15 (9,
CITY OF CARMEL, INDIANA VENDOR: 369422
ONE CIVIC SQUARE CASSIE STREETER CHECK AMOUNT: $*******498.19*
CARMEL, INDIANA 46032 N702NORWSL NO AVE CHECK NUMBER: 245997
CHECK DATE: 06/03/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1125 4343000 498.19 TRAVEL FEES & EXPENSE
Carmel * Clay RE714 ?015
Parks&Recreation MAEmployee Expense Reimbursement Request 0 1/:__
Date of Fund Account Account
Receipt Vendor listed on receipt # Line# Budget Description Amount Purpose of Expense
VCdd ?"k vt /176. / L1c/360o d® A
s/'7 Cori We ary aft ., .• •• $ q. L4a C 8re-0-kRxS i-
,-`' w6err �, �. 6S D LULn Clh
-5` 1 L6U- Alc nAQ -i %S ?l-Z-ie-rIlA. ee `® {e a♦ to `a Z® . ®® E Linnet
ra- Lc.%.nc,h
N4W Desi v► OW erriclb Chdo 5 4
All receipts should be attached in the same order as listed above. .-I 3
No sales tax will be reimbursed. TOTAL:
Employee Name(print) Ca531e• 5t re e---oar
Address Ljj c)7• t'1 OW INS �
Check
payable to: City, St,Zip l(1C�1 Ql1Q, b`dS fo o�O
Signature: Approved by:
Date: 1 . 1 Date: f2113,115
T
Business Services Division,Revised 7-7-08
FILE: Shared\Administrative\Forms\Staff Forms\Employee Exp Reimb Request
Hyatt Regency Chicago
151 East Wacker Drive
Chicago, IL 60601
Tel: 312.565.1234
Fax: 312.239.4414
www.chicagoregency.hyatt.com
INFORMATION INVOICE
L11MAY 18 2015Payee Cassie Streeter Room No. 0429
1411 E 116th Street
Carmel IN 46032 Arrival 05-06-15
Departure 05-08-15
Page No. 1 of 1
Confirmation No. 6103917901 Folio Window 1
Group Name F&W Media Inc-HOW Design Conf Folio No. 1710188
Booking No. 32C58GWP
Date Description Charges Credits
05-07-15 Valet Parking 5/6 _ 63.00
05-07-15 Valet Parking 5/7 63.00
05-08-15 Visa XXXXXXXXXXXX5926 XX/XX 126.00
Total 126.00 26.00
Guest Signature Balance 0.00
I agree that my liability for this bill is not waived and I agree
to be held personally liable in the event that the indicated Thank you for choosing the Hyatt Regency Chicago.
person,company or association fails to pay for any part or Please feel free to provide us with feedback regarding our visit.
the full amount of these charges. P 9 9 Y
µ ... ....... Please send comments to Hyatt at q_ualitychirc hyatt.com or 888-565-5586.
Hyatt Gold Passport Summary
. For inquiries concerning your bill please call 855-869-0846
No Membership to be credited
Please remit payment to:
Join Hyatt Gold Passport today and start Hyatt Regency Chicago
earning points for stays, dining and more. Lockbox 301588
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FEIN#94-1649123
PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM NO.101(1986)
MILEAGE CLAIM CWS1"e
(GOVERNMENTAL UNIT) ON ACCOUNT OF APPROPRIATION NO. FOR ��• '� �
(OFFICE,BOARD,DEPARTMENT OR INRnTVTION) I -
I
I
DATE FROM TO SPEEDOj AUTO MILEAGE
MILES 0
POINT POINT START FINISH NATURE OF BUSINESS TRAVELED
t PER MILE
#low to "Irtil d_ GP • ► o f a��LCL O X.
�Y1 Z3s tNl. t � -a �* `• •• ! S cas t" Z
AUTO LICENSE NO. TOTALS ?,I
+ SPEEDOMETER READING columns are to be used only when distance between points cannot be determined by fixed mileage or official highway map.
I
Pursuant to the provisions and penalties of Chapter 155,Acts 1953;I hereby certify that the foregoing account is just and correct,that the amount claimed is legally due,-after allowing all just credits:
end that no part of the same has been paid. /�
Date s -r f� 1 wtj
J v
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice of bill to be properly itemized must show; kind of service,where performed, dates service rendered, by
whom rates per day, number of hours, rate per hour, number of units, price per unit, etc.
Payee
Purchase Order No.
Streeter, Cassie Terms
4702 Norwaldo Ave
Indianapolis, IN 46205
Invoice Invoice Description
Date Number (or note attached invoice(s)or bill(s)) PO# Amount
5/13/15 Reimb Travel expenses for Designer conference $ 287.73
5/13/15 Reimb Mileage Designer Conference $ 210.46
Total $ 498.19
1 hereby certify that the attached invoice(s),or bill(s)is(are)true and correct and I have audited same in accordance
with IC 5-11-10-1.6
, 20
Clerk-Treasurer
II
Voucher No, Warrant.No.
Streeter, Cassie Allowed 20
4702 Norwaldo Ave
Indianapolis, IN 46205
,In Sum of$
I� I
$ 498.10
ON ACCOUNT OF APPROPRIATION FOR I
101 -'General Fund,
PO#or: ., INVOICE NO. -CGTWTITL AMOUNT Board Members
Dept#
1125, Reimb.. 4343000;: $ 287.73.: 1 hereby certify that the attached invoice(s), or
1125 Reimb 434300' $ 210.46 bill(s)is(are)true and correct and that the
materials or services itemized thereon for
which charge is made were ordered and
received except
May 28, 2015
N`
Signature
$ 498.19 Accounts Payable Coordinator
Cost distribution ledger_classification if" Title
claim paid motor vehicle highway fund